Mycophenolate mofetil in the treatment of glomerular diseases

Treatment of primary glomerular diseases may be unsuccessful or have potential toxicities. Mycophenolate mofetil (MMF) is a new, relatively non-toxic drug. It has been introduced as an immunosuppressive drug, but it also has effects on non-immune cells (vascular smooth muscle cells, fibrocytes). Therefore, we evaluated the use of MMF for the treatment of glomerular diseases at different stages of the disease.

The daily dosage of MMF was 2 for the first 6 months and 1.5 g for a further 18 months, combined with steroids. The follow-up period was two years.

18 patients with lupus nephritis were treated. Patients with a high histological activity index showed a significant decrease of serum creatinine (p < 0.05) and proteinuria (p < 0.01), while patients with a high chronicity index showed only a decrease of proteinuria (p < 0.05). 15 patients with membranous nephropathy were treated. They showed stable renal function and a significant decrease of proteinuria (p < 0.05). Complete remission was achieved only in patients with MMF as a first choice drug. 4 patients with focal segmental glomerulosclerosis did not show any significant decrease of proteinuria, while the nephrotic syndrome in minimal change nephropathy (3 patients) showed a complete recovery. Partial improvement of the nephrotic syndrome was noted in 5 patients with membranoproliferative glomerulonephritis and in 4 patients with crescentic glomerulonephritis. Patients with crescentic glomerulonephritis also presented a significant decrease of serum creatinine (p < 0,05). MMF in 3 patients with IgA nephropathy grade I showed a significant improvement of the nephrotic syndrome. In grade III (5 patients) the response was partial.

We can conclude that MMF in our patients showed both actions, as an immunosuppressive drug in the early stages of the disease, and as an anti-fibrotic agent in the chronic phase of the disease.